Rhinitis is an inflammatory state of the nasal passages that is generally characterized by symptoms such as nasal drainage, nasal itching, sneezing, and/or nasal congestion. Acute rhinitis, such as that associated with viral upper respiratory infections, generally resolves after immunological clearance of the offending organism. Conversely, patients with chronic rhinitis tend to have a clinical course characterized by long-term persistent or recurrent symptoms. Affecting nearly one quarter of Westernized populations, rhinitis has been shown to have a significant impact on overall health and productivity. Rhinitis has shown to be a possible predictor of future asthma in children. Rhinitis also contributes to poor school and work performance.
Chronic rhinitis is broadly organized into allergic and non-allergic forms. Traditionally, allergic rhinitis has been categorized as either seasonal or perennial. However, since many patients are sensitive to both seasonal and perennial allergens, this categorization is being challenged. A newer categorization based on the timeline (intermittent or persistent) and severity (mild or moderate/severe) of symptoms is increasingly used. The treatment for allergic rhinitis depends on the severity and persistence of symptoms. The mainstay of medical therapy includes one or more of the following and is titrated to the patient's response and tolerance: antihistamines; steroids; leukotriene receptor antagonists; leukotriene synthesis inhibitors; mast cell stabilizers; anticholinergic drugs; and monoclonal antibody therapy.
Avoidance of offending pollens or foods is also a mainstay of therapy. For those patients who fail cannot tolerate medical therapy, allergy immunotherapy is offered as a treatment alternative. Although immunotherapy can be quite effective, it may take years of weekly treatments (subcutaneous shots), usually performed at the treating physician's office, to achieve long-term efficacy. Furthermore, many patients with significant symptoms (up to 25%) remain symptomatic despite ongoing immunotherapy.
Non-allergic rhinitis (NAR) is similar to allergic rhinitis, although ocular symptoms such as redness, itching or tearing are less common in NAR. Classification of NAR is simple, as there are many subtypes of NAR, both inflammatory and non-inflammatory. Inflammatory non-allergic rhinitis may be associated with occupational exposure, drugs (including prescription and over-the-counter), infection, and NAR with eosinophilia syndrome. Non-inflammatory NAR may be one of the following forms: emotional; idiopathic; atrophic; gustatory; vasomotor; hormonal; or drug related (such as rhinitis medicamentosa). Treatment is aimed at addressing the offending etiological factor (such as stopping the use of topical decongestants for patients with rhinitis medicamentosa). In select cases, steroids, antibiotics, anticholinergics, or other medications as noted for allergic rhinitis may be of benefit. However, for many NAR patients, there exists no optimal or effective treatment.